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. Fro�m:ALLSTAR CONSTRUCTION 19529427464 07l30/2013 14:06 #219 P.002/011 STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimensfo�s(continued) 2.Type o(Constructlon a. Length(ft.)= 1� Number of bedrooms= �Wood/Frame b.Width(ft.)= I � Number of garage stalis: Masonry Areas in sauare feet Attached= ❑Metal ❑Poie Bidg. c. Basement= Detached= ❑ICF d. 1�Story = ❑On-site Prefab e.2nd Story= ❑Off-site Prefab f. '/�Story = ❑Other(piease specify): g.Totai Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for our a licat+on to be rocessed: Not Enclosed A licable ❑ ❑ Permit A lication ❑ ❑ Pro osed Buildin Plans ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form O ❑ Surve meetin all r uirements ❑ ❑ Stormwater Pollution Preven6on Plan ❑ ❑ Hardcover Calcutation s � ❑ Se tic S tem Site Evaluation Re rt 0 ❑ Accass Permit ❑ ❑ Wetland BufEer Im rovement Plan ❑ ❑ En ineered Plans for Retainin Walis 4 feet or above ❑ O Minnehaha Creek Watershed Distnct Permit s ❑ ❑ Plan Review Fee ❑ ❑ Application Escrow&Agreement O O Other: APPLICANT/OWNER ACKNOWLEDGEM�NT: • Agrees to provide all information required or requested by the Building Department; • Agrees to pay the City of Orono for engineering consultant review costs in excess of 5500; . Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative but to reject it untfl it is camplete; . Adcnowledges the Escrow Agreement is completed and signed; • Understands some or all of the information that you are asked to provide on this application is dassified by State law as either , private or confiden6al. Private data is information which generally cannot be given to the public but can be given to tl�e subject , of the data. Confidential data is information which generalfy cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If you refuse to supply the information,the applica6on may not be issued. • ' �ipr��1►:a�in th�.ewenx that�►�a�sr or,p'ther�o�iiqc�ns'�revent�he�omP��pn oi�n�s�u��sui�reX at th��ime tha. Ce�#lfi�a�q af Ck�up�tney#s��e�ted,,a��m,pa�rY�e,r�lf�Cats of��uPan�Y.may be aep�tpd uPcr�rec�ipR:of a��p;0'� eaarowi W:e,ri"sure:+�omple�lon af the as-du.ilt s.arvay:and,alt:stta�mp��nents:.' ApplicanYs Signatur � Date: 7/.3�r�/3 Owner's Signature: Date: :